Associations between Long-Term Ambient PM <sub>2.5</sub> Exposure and Prevalence of Chronic Kidney Disease in China: A National Cross-Sectional Study

Abstract

Background: Chronic kidney disease (CKD) is one of the important global public health challenges. However, evidence regarding the associations between PM2.5 exposure over a broad range and CKD prevalence in the general population is extremely limited. Our aim is to explore the associations between long-term exposure to ambient PM2.5 and prevalence of CKD based on the China National Survey of CKD. Methods: A cross-sectional survey of a nationally representative sample of 47 204 Chinese adults recruited at 13 provinces from different provinces was conducted from September 2009 to September 2010. Annual exposure to PM2.5 prior to the survey date was estimated at each participant’s address using validated satellite-based spatiotemporal model with a 10km×10km resolution. Participants with estimated glomerular filtration rate (eGFR) <60 mL/min/1・73 m 2 or with albuminuria were defined as CKD. Generalized additive mixed effects models were used to estimate the associations, and the influences of the potential modifiers were also analyzed. Findings: Two-year mean PM2.5 concentration was 57・4 μg/m3, with a range from 31・3 to 87・5 μg/m3. A 10 μg/m3 increase in PM2.5 was positively associated with the prevalence of CKD with an odds ratio (OR) of 1・33 (95% confidence interval [CI]: 1・25, 1・41) and albuminuria with an OR of 1・47 (95% CI: 1・38-1・58). Stratified analyses indicated the associations were stronger in participants <65 years (vs. participants ≥65 years), in participants with normal weight (vs. overweight participants), and in participants without comorbid diseases (vs. those with comorbid diseases including diabetes, hypertension, and cardiovascular disease). Interpretation: This study showed a significant association between long-term PM2.5 exposure over a broad range and increased prevalence of CKD in the national representative general population. The findings will provide important evidence for policy markers and public health practices to reduce the disease burden of CKD related to ambient PM2.5 pollution. Funding Statement: This study was supported by grants from the National Natural Science Foundation of China (91846101, 81771938, 81301296, 81502780), Beijing Nova Programme Interdisciplinary Cooperation Project (Z191100001119008), the National Key R&D Program of the Ministry of Science and Technology of China (2016YFC1305400, 2017YFC0211601), the University of Michigan Health System-Peking University Health Science Center Joint Institute for Translational and Clinical Research (BMU20160466, BMU2018JI012, BMU2019JI005), and from Peking University (BMU2018MX020, PKU2017LCX05, PKU2019LCXQ008). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The ethics committee of Peking University First Hospital approved the study. All the participants gave written informed consent before data collection.